Telemedicine Consult to On-Call Clinician

Overview#

A paramedic at a complex scene can call up an on-call hospital clinician on video, share live vitals and a 12-lead ECG, and document the second opinion against the canonical incident, supporting hear-and-treat or specialist-pathway decisions without leaving the scene.

The Telemedicine Consult module gives the on-scene crew a one-tap WebRTC video bridge to an on-call clinician, such as a consultant emergency physician, a paediatric specialist, or a mental-health liaison. Vitals stream in-band as a video overlay, the ECG waveform is mirrored to the clinician view, and the session is recorded with consent and bound to the active encounter so the consultation becomes part of the auditable incident timeline rather than a side channel.

Last Reviewed: 2026-05-05 Last Updated: 2026-05-05

Key Features#

• One-Tap Consult Launch from the Encounter: Crews start the video session directly from the active encounter so the consultation is bound to the patient case rather than created as a disconnected call.

• Specialist On-Call Routing: Calls are routed to the appropriate on-call clinician profile, such as emergency physician, paediatric specialist, or mental-health liaison, rather than to a generic queue.

• WebRTC Video and Audio Bridge: The session uses standards-based real-time media so the clinician can see the patient and the scene with low latency over modern mobile networks.

• In-Band Vitals Overlay: Patient vitals from the connected monitor are rendered into the clinician's video view so they read the trend at the same moment the crew describes the patient.

• 12-Lead ECG Mirror: The ECG waveform from the field is mirrored into the clinician console so a second pair of eyes can interpret the rhythm in real time.

• Consent-Captured Session Recording: The session can be recorded with explicit consent and the resulting media is treated as clinical evidence rather than free-floating video.

• Chain-of-Custody Evidence Storage: Recording artefacts are written as incident evidence attachments, hashed and signed so the clinical review can stand up to later audit.

• Clinician Decision Logged on Incident Timeline: The session start, end, and the clinician's documented decision are written to the canonical incident timeline alongside other clinical events.

• Hospital Identity Federation: The clinician authenticates from the hospital identity domain rather than receiving a separate platform account that has to be lifecycle-managed.

• AI Partner Surfacing of Prior Context: Prior encounter context, allergies, and recent observations can be surfaced to the clinician at session start so the conversation does not begin from a blank screen.

Use Cases#

• Avoidable Conveyance Avoidance: A crew uses the consult to confirm a hear-and-treat decision on a stable patient who would otherwise have been conveyed because no specialist sign-off was reachable.

• Paediatric Scene Decision Support: A paramedic with a critically unwell child consults a paediatric specialist on video to validate airway, dosing, and destination decisions before moving.

• Mental-Health Liaison Review: A crew at a mental-health presentation brings in a liaison clinician to support a non-conveyance plan with safe community follow-up rather than a default ED transport.

• Cardiac Pathway Activation: An on-scene 12-lead is mirrored to the on-call cardiology clinician who confirms STEMI activation directly into the canonical incident.

• Remote or Rural Scene Support: A crew operating far from a receiving hospital uses video consult to share scene context that a phone call could not convey, before committing to a long transport.

• Complex Trauma Second Opinion: A senior emergency physician views the scene and patient in real time and helps the crew decide between local stabilisation and direct trauma centre conveyance.

• Auditable Clinical Decision Record: The recorded session, vitals snapshot, and clinician decision become an evidenced second-opinion record attached to the incident, available for governance review.

Integration#

• ePCR Clinical Workspace: The consult is launched from, and writes back to, the active encounter so the clinical record stays the system of truth rather than competing with a separate video tool.

• Canonical Incident Timeline: Session lifecycle events and the clinician's documented decision flow onto the incident timeline alongside dispatch, scene, and handover events.

• Incident Evidence Attachments: Recordings are persisted as evidence_class='video' attachments, hashed and signed for chain-of-custody handling consistent with other scene evidence.

• Hospital SMART on FHIR Identity: Clinician access uses SMART on FHIR Backend Services so the hospital identity domain controls who can answer a consult.

• HealthLink Outbound Vitals: A vitals snapshot taken at consult start can be transmitted to the receiving hospital using the existing HealthLink ORU pathway.

• WebRTC TURN Infrastructure: Session media uses the platform's TURN binding so crews on constrained mobile networks still establish reliable encrypted media sessions.

• CloudEvents Eventing: Session lifecycle is emitted as argus.telemed.session_started and argus.telemed.session_ended events for downstream observability and analytics.

• Crew and Clinician Mobile Surfaces: The crew uses the responder mobile telemed screen, the clinician uses the hospital-side console, and both views are bound to the same encounter context.

Open Standards#

• W3C WebRTC: peer-to-peer real-time video and audio between the on-scene crew and the on-call clinician uses the standard browser real-time communications model.

• SRTP (RFC 3711): media is carried over the standard secure real-time transport profile so audio, video, and the ECG mirror remain encrypted in transit.

• DTLS (RFC 9147): media key exchange follows the standard datagram TLS pattern used by interoperable real-time communications systems.

• IETF SDP (RFC 8866): session description and negotiation use the standard offer/answer model expected by interoperable WebRTC endpoints.

• SMART on FHIR Backend Services: clinicians authenticate from their hospital identity domain using the standard backend services authorisation model rather than a bespoke account scheme.

• HL7 FHIR R4 Communication: the consult thread, including notes and decision context, is persisted using the standard FHIR Communication resource pattern.

• HL7 v2.4 ORU (HealthLink): outbound vitals snapshots taken at consult time use the standard observation result message format already accepted by hospital systems.

• eIDAS 2.0: clinician identity attestation aligns with the European trust framework for qualified electronic identity so the second opinion carries a recognised identity assurance.

• CloudEvents 1.0: session lifecycle events are emitted in the standard CloudEvents envelope so downstream systems can subscribe without bespoke contracts.